COMMENT KATARZYNA

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  I NEED A POSITIVE COMMENT BASEDIN THIS ARGUMENT..BETWEEN 100-120 WORDS

 

  1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.

My recommendations for continued treatment would be:

  • Start antibiotics “Patients with diabetes mellitus are at increased risk of invasive S. aureus infections.” (Hakeem, L., Laing, R. et al, 2013).
  • Tylenol to reduce the fever.
  • Pain medicine should be administered as needed.
  • Order wound consult so that the wound can be assessed appropriately and recommendations for wound care can be made. The wound may require debridement in order to promote healing.
  • Elevate the legs to promote venous blood return and apply compression stocking to the other extremity.
  • Appropriate high protein diet to promote wound healing.
  • Case management should be consulted to start discharge plan.

 

2)     Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”

Muscle groups affected by Ms.G condition are: flexor hallucis longus, flexor digitorum longus, and tibialis anterior.

3)       What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.

The subjective and objective data is vital in prevention of future worsening or recurring of infection. Information that MS. G presented with should be indication for future recommendations for her. With Ms. G’s young age and diabetes we know that she is more prone to have venous ulcers; therefore education and prevention will be crucial in her case. Understanding disease process, controlling her blood sugar level, proper diet with right amount of protein, weight loss and wearing compression stockings will be information that patient needs to be provided and followed up with.

4)      What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

The main factor present in this situation that could prevent wound healing is diabetes disease. “Healing problems are caused by the peripheral arterial diseases and peripheral neuropathy that can occur with diabetes”

Brem, H., Tomic-Canic, M, 2007). One of the characteristics of patients with diabetes is  poor circulation, especially to extremities. Reduced amount of oxygen and nutrients delays healing. Ms G. needs consistent blood sugar control along with medication available for her to decrease high blood sugar. Another risk factor is that MS G. lives alone and does not have help with meal preparation. Proper diet high in protein is crucial in wound healing. Education along with case management involvement will be priority to ensure right nutrition.

 

 References:

 

Brem, H., & Tomic-Canic, M. (2007). Cellular and molecular basis of wound healing in diabetes. Journal of Clinical Investigation, 117(5), 1219–1222. http://doi.org/10.1172/JCI32169

 

Hakeem, L., Laing, R. et al (August 21, 2013). Invasive Staphylococcus aureus infections in diabetes mellitus.Retrieved from http://journals.sagepub.com/doi/abs/10.1177/1474651413500830#articleCitationDownloadContainer

 

COMMENT CARLOS DQ2

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

One of the main issues noted at the Ben Archer Health Clinic in Las Cruces in addressing evidence based practice is meetings only happen once a month (Chaires, 2017). That is the only time they are able to get everyone together at one time and dissiminate important information.  While it sounds like the best opportunity for addressing a solution, there is so much information that needs to be given, it tends to be overwhelming.  “The top three barriers to adopting evidence based practice were lack of time, inability to understand statistical terms, and inadequate understanding of the jargon used in research articles” (Majid et. al., 2011). Enough time is needed to give the information, and to process it.  The first step to resolving this would be set a time specifically to address one issue and solution at a time.  It cannot be a time when other information is being given.  Whether they add an inservice once a month, or do it every other month during their monthly meetings, a time needs to be set aside just for this one thing.  Every other month would be a good way to start.  Have one month where information is given out, and the next for an evidence based practice inservice.  It would be helpful to give everyone information prior to the meeting (an email, or flyer, with the general overview).  This will allow everyone to be familiar with the information prior to the meeting so that not too much new information is thrown at them at once.  

References:

Chaires, K. (2017). [Personal interview].

Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses perceptions, knowledge, and barriers. Journal of the Medical Library Association : JMLA, 99(3), 229-236. doi:10.3163/1536-5050.99.3.010

 

COMMENT CATHERINE

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

A Clinical Nurse Leader (CNL) is a master’s level educated nurse. In order to earn an MSN degree, nurses must first complete their Bachelor of Science degree and pass the NCLEX-RN exam. RNs may then advance to a Master’s of Science Clinical Nurse Leader program, in which they will take advanced courses in pathophysiology, clinical assessment and pharmacology. The final step in becoming a clinical nurse leader is obtaining the Clinical Nurse Leader Certification from the Commission on Nurse Certification (Registered Nursing.org, n.d.,)

The Clinical Nurse Leader (CNL) role is designed to deliver clinical leadership in all health care settings. The Clinical Nurse Leader role was developed by the American Association of Colleges of Nursing (AACN) through collaboration between academic and practice leaders in response to quality and safety issues identified by The Institute of Medicine (IOM) reports in 2000 (Registered Nursing.org, n.d.,).

 CNLs are highly trained nurses who plan, direct and supervise patient care. They’re focused on health outcomes within a certain group or community, whether it’s a hospital unit, a home health agency or an elementary school. Whatever the setting, the CNL ensures that patients and populations receive high-quality, research-based and appropriate medical care and health promotion services. A core principle of the clinical nurse leader role is identifying and implementing methods for reducing healthcare costs for the institution.

The role(s) of the CNL designation can include the following:

Cost/financial outcomes such as length of stay, patient flow, readmission rate and registered nurse (RN) turnover

Patient satisfaction, staff satisfaction and retention

Quality/internal process outcomes such as medication management, patient safety, and prevention of nosocomial infections

Practice Model Transformation such as evidence-based and collaborative, interdisciplinary practice

Role influences point of care and organizational culture

Role partners with nurse manager

A CNL would help patients and families navigate through the complex and diverse, often fragmented health-care system. They are usually involved in the direct care of patients; they would provide education based on the patient’s plan of care, for example, an insulin dependent diabetic.

References

Registered Nursing.org (n.d.,). Clinical Nurse Leader. What Is a Clinical Nurse Leader? Retrieved from https://www.registerednursing.org/clinical-nurse-leader/#clinical-nurse-leader

COMMENT CARLOS

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

The organization I chose to do my practicum at is a health clinic that services an assortment of patients.  They pride themselves on caring for patients regardless of payment, and their mission statement states: “Our mission is to significantly improve the health status of its population through the prevention of illness, the promotion of health education, the provision of quality primary care, access to the under-served and a strong commitment to chronic disease” (BAHC, n.d.).  There are 11 clinics across New Mexico.  The majority of the population seen at the Las Cruces clinic are Hispanics.  One of the most common diagnoses seen is GERD and heartburn. While GERD is common in Hispanics, there is not a lot of evidence that says spicy foods itself causes it (a staple in Mexican diets). “While there’s some evidence these foods can trigger heartburn, experts say how you eat is more important than what you eat when it comes to controlling painful flare-ups” (Heid, 2015). This is a health education issue that I feel needs to be addressed.  Too often, it’s the type of food that gets blamed (spicy to be exact), rather than the when, how, and why.    This needs to be address as it has a few implications for nursing.  One, many patients self-medicate.  They take over-the-counter Zantac or Pepcid or other antacids instead of being treated by a provider and educated, so when they do get seen, they have worse issues than the original problems.  Another implication is this leads to worse issues and further studies being done.  Endoscopies, colonoscopies and such, as well as studies for H. Pylori.  This adds to patients being admitted, which adds to the patient load that is already stressed on the inpatient floors.  References:  BAHC. (n.d.). About Us . Retrieved from https://bahcnm.org/site/about.php#mission Heid, M. (2015, October 30). It’s Not Food Causing Your Heartburn-Here Are The 5 Real Culprits. Retrieved from https://www.prevention.com/food/5-real-causes-heartburn

COMMENT KATARZYNA

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  I NEED A POSITIVE COMMENT BASEDIN THIS ARGUMENT..BETWEEN 100-120 WORDS

 

  1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.

My recommendations for continued treatment would be:

  • Start antibiotics “Patients with diabetes mellitus are at increased risk of invasive S. aureus infections.” (Hakeem, L., Laing, R. et al, 2013).
  • Tylenol to reduce the fever.
  • Pain medicine should be administered as needed.
  • Order wound consult so that the wound can be assessed appropriately and recommendations for wound care can be made. The wound may require debridement in order to promote healing.
  • Elevate the legs to promote venous blood return and apply compression stocking to the other extremity.
  • Appropriate high protein diet to promote wound healing.
  • Case management should be consulted to start discharge plan.

 

2)     Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”

Muscle groups affected by Ms.G condition are: flexor hallucis longus, flexor digitorum longus, and tibialis anterior.

3)       What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.

The subjective and objective data is vital in prevention of future worsening or recurring of infection. Information that MS. G presented with should be indication for future recommendations for her. With Ms. G’s young age and diabetes we know that she is more prone to have venous ulcers; therefore education and prevention will be crucial in her case. Understanding disease process, controlling her blood sugar level, proper diet with right amount of protein, weight loss and wearing compression stockings will be information that patient needs to be provided and followed up with.

4)      What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

The main factor present in this situation that could prevent wound healing is diabetes disease. “Healing problems are caused by the peripheral arterial diseases and peripheral neuropathy that can occur with diabetes”

Brem, H., Tomic-Canic, M, 2007). One of the characteristics of patients with diabetes is  poor circulation, especially to extremities. Reduced amount of oxygen and nutrients delays healing. Ms G. needs consistent blood sugar control along with medication available for her to decrease high blood sugar. Another risk factor is that MS G. lives alone and does not have help with meal preparation. Proper diet high in protein is crucial in wound healing. Education along with case management involvement will be priority to ensure right nutrition.

 

 References:

 

Brem, H., & Tomic-Canic, M. (2007). Cellular and molecular basis of wound healing in diabetes. Journal of Clinical Investigation, 117(5), 1219–1222. http://doi.org/10.1172/JCI32169

 

Hakeem, L., Laing, R. et al (August 21, 2013). Invasive Staphylococcus aureus infections in diabetes mellitus.Retrieved from http://journals.sagepub.com/doi/abs/10.1177/1474651413500830#articleCitationDownloadContainer

 

comment julia aman

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 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 150-200 WORDS

 

Principalism is a concept made up of four ethical principles that outline the basics of bioethics. These principles include respect for autonomy, nonmaleficence, beneficence, and justice. Respect for autonomy can be described as respect for the decisions made by autonomous persons. Nonmaleficience means doing no harm to others. Beneficence describes the principles of preventing harm, providing benefits, and doing what is in the best interest of others. Justice describes fair distribution of benefits, risks, and costs (Beauchamp and DeGrazia, 2004).

 

I would personally rank the four principles as follows:

  1. Nonmaleficence
  2. Beneficence
  3. Autonomy
  4. Justice

I think as a society, we should “first do no harm” and take care of each other as fellow human beings. Secondly, I would rank beneficence, as this principle gives us all an opportunity to do no harm plus to do good for others. Autonomy gives us the freedom to choose what we wish to do and what good we choose to participate in. Justice ensures all humans are fairly represented and that everyone is a recipient of the beneficence of others. I think the Christian narrative would rank the principles in the order of nonmaleficence, beneficence, justice, and autonomy last. To live as Christ lived would be to put the needs of others before our own.

 

According to our lecture, principalism in the United States, particularly regarding bioethics, has been critiqued for raising autonomy to the most important principle on the list (Lecture 3, 2015). I can see where this concern is coming from, as American culture tends to get selfish and people forget to balance their needs with the needs of others. I can think of a personal example from working in the hospital that was most disturbing to me. We had a 23 year old woman on our unit with chronic GI issues that was well known to the entire hospital for being a drug seeker who tried to manipulate providers and exercised control by refusing aspects of her care – gait belts, lab draws, vital signs, you name it. Her refusal of an initial colonoscopy led to multiple infections throughout her hospital stay. I was frustrated one night because she refused to let me change the dressing on her infected IJ line, and my sentiment echoed that of all the nurses and doctors at the hospital: “what is she doing here if she will not let us help her get better?” I spoke with my nurse manager about this, and while she acknowledged my concerns, we could not force her to do anything she refused – we could only document it. This patient later overdosed on heroin that her boyfriend brought to the hospital for her and remained in the ICU for months. So yes, according to the principle of autonomy, this patient had a right to make all the decisions that caused her condition to worsen. I think American culture could use a little modification on the importance of autonomy. Although this woman was competent, her drug addiction heavily influenced her mental capacity. I struggle with the fact that “we could only document her refusal,” when she really should have had access to mental health services and addiction counseling. The hospital system could have done better to prevent harm and offer her the services she needed.

 

Beauchamp, T. L., and DeGrazia, D. (2004). “Principles and principalism” in Philosophy and medicine vol. 78. Handbook of bioethics: Taking stock of the field from a philosophical perspective. Dordrecht: Kluwer Academic Publishers.

 

Lecture 3. (2015). PHI-413V: Biomedical Ethics in the Christian Narrative. Phoenix, AZ: Grand Canyon University.

COMMENT CARLOS

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

The organization I chose to do my practicum at is a health clinic that services an assortment of patients.  They pride themselves on caring for patients regardless of payment, and their mission statement states: “Our mission is to significantly improve the health status of its population through the prevention of illness, the promotion of health education, the provision of quality primary care, access to the under-served and a strong commitment to chronic disease” (BAHC, n.d.).  There are 11 clinics across New Mexico.  The majority of the population seen at the Las Cruces clinic are Hispanics.  One of the most common diagnoses seen is GERD and heartburn. While GERD is common in Hispanics, there is not a lot of evidence that says spicy foods itself causes it (a staple in Mexican diets). “While there’s some evidence these foods can trigger heartburn, experts say how you eat is more important than what you eat when it comes to controlling painful flare-ups” (Heid, 2015). This is a health education issue that I feel needs to be addressed.  Too often, it’s the type of food that gets blamed (spicy to be exact), rather than the when, how, and why.    This needs to be address as it has a few implications for nursing.  One, many patients self-medicate.  They take over-the-counter Zantac or Pepcid or other antacids instead of being treated by a provider and educated, so when they do get seen, they have worse issues than the original problems.  Another implication is this leads to worse issues and further studies being done.  Endoscopies, colonoscopies and such, as well as studies for H. Pylori.  This adds to patients being admitted, which adds to the patient load that is already stressed on the inpatient floors.  References:  BAHC. (n.d.). About Us . Retrieved from https://bahcnm.org/site/about.php#mission Heid, M. (2015, October 30). It’s Not Food Causing Your Heartburn-Here Are The 5 Real Culprits. Retrieved from https://www.prevention.com/food/5-real-causes-heartburn

COMMENT IJEOMA

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I NEED A POSITIVE COMMENT BASEDIN THIS ARGUMENT..BETWEEN 100-120 WORDS

Identify the educational preparation and role(s) of the clinical nurse leader (CNL) designation. Give an example of how the CNL influences direct patient care whether in a hospital or out in the community.

 

Clinical nurse leader (CNL) was proposed American Association of Colleges of Nursing, an effort to improve patient safety and quality of care (Graduate Nursing Edu.org). CNL is a generalist clinician who have education at master’s degree level or higher (Graduate Nursing Edu.org), upon graduation must sit for Clinical Nurse Leader Certification Examination by the Commission on Nurse Certification (University of Pittsburgh). A CNL has an advanced knowledge, not just in one area or discipline, but on general medicine, which is helpful for coordinating the care provided by the interdisciplinary teams.  

CNL has roles different from other advanced practice clinicians, they are responsible for designing patient care, implementing, and evaluating the care provided to the patients, making sure that the patients receive the right care, while coordinating, delegating, and supervising the care provided by other health care teams clinically.

CNL can influence patient care by the use evidence-based practice and the latest innovated technology to improve patients’ care, they work with physicians, pharmacists, nurse practitioners and other health care teams to provide the most effective medical care (Graduate Nursing Edu.org). It is important to know that CNL serve as mentors to nursing staff, oversee the environment to ensure it is safe for the patients.

CNL can act like a patient’s advocate; they serve as a middle person between the patients and they physicians or healthcare providers. For example, a patient in the community who is not sure what and where to go for help, a CNL would use his/her expertise to inform or teach the patients and family members, the disease condition, and its management, and refer them to the appropriate places for best care.

 

                                                                                  References

Graduate Nursing Edu.org. (2017) Retrieved on October 2nd. From https://www.graduatenursingedu.org/clinical-nurse-leader/

University of Pittsburgh (2017) Clinical Nurse Leader (CNL). Retrieved October 2nd from http://www.nursing.pitt.edu/degree-programs/master-science-nursing-msn/msn-program-majors/clinical-nurse-leader-cnl-onsite

 

 

 

Discussion _ !

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Preventing use of tobacco and helping those who utilize it to stop can have continuing benefits for people and for the public health in general. Advanced practice nurses can engage in activism and prevent Big Tobacco from further disabling the health of many communities by developing and implementing tobacco management programs to assist to reduce or prevent the use of tobacco. These programs can make use of taxation, mass-media campaigns, restrictions and easily accessible and effective behavioral analysis and tobacco ending medications. The programs can provide services to different target audiences, including young individuals, people with co morbid health issues, those of different socioeconomic status and ethnicities, and women (Diem & Moyer, 2015). A comprehensive approach to tobacco management results in changes that affect the whole population, from the person to the community level, by addressing the social, political economic, cultural and environmental aspects that sustain the using and not using of tobacco. 

Another way that advanced practice nurses can engage in activism and prevent Big Tobacco from further disabling the health of many communities is through the use of Evidence-based best practices for tobacco control (Stanhope & Lancaster, 2014). Programs for tobacco control reduce use of tobacco at the populace level by building tobacco-free outdoor and indoor areas, limiting the access of young people to tobacco products, restricting tobacco marketing, having continuous counter marketing campaigns, increasing the price of tobacco products, and offering easily available tobacco termination services and products.

References

Diem, E. & Moyer, A. (2015). Community and public health nursing: learning to make a difference through teamwork. Toronto: Canadian Scholars’ Press.

Stanhope, M. & Lancaster, J. (2014). Public health nursing: population-centered health care in the community. Maryland Heights, Missouri: Elsevier Mosby.

P5

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Hello i need a Good and Positive Comment related with this argument .A paragraph  with no more  100 words.

 

 

ChristineTarbox 

 

1 posts

 

Re:Topic 1 DQ 1

 

A nursing shortage has been shown to decrease patients access to care, decrease job satisfaction, and increase nurse turnover (Huber, 2010).  “The current nursing shortage is anticipated to become twice as large as any nursing shortage experienced since the 1960s” (O’Neil, 2009, p. 180, para 7).  Nurse shortage has been a significant focus of study and debate because of the enormous effect it has on all of us at every possible level of healthcare. Numerous research studies have been conducted to determine the main factors driving the nursing shortage.  “This shortage is not solely nursing’s issue and requires a collaborative effort among nursing leaders in practice and education, health care executives, government, and the media” (Nevidjon & Erickson, 2001).  Factors contributing to the nursing shortage include the following:  Nursing school enrollment is not growing fast enough to meet the projected demand for RN and APRN services, nursing school faculty shortage is restricting nursing program enrollments, a significant percentage of the current nursing workforce is nearing retirement age, there is an increased need for nursing care because of our aging population, and  insufficient staffing is intensifying nurses’ stress level which impacts job satisfaction and drives many nurses to leave the profession.

 

Although there has been a 3.6% increase in baccalaureate nursing program enrollment in 2016 according to the AACN (2017), this increase is not even close to sufficient enough to meet the projected demand for nursing faculty, researchers and primary care providers.  The AACN also reports that nursing schools in the U.S. turned away 64,067 qualified applicants in 2016 due to an insufficient number of faculty, clinical sites, clinical preceptors and budget limitations. Nevidjon & Erickson discuss multiple collaborative recruitment efforts happening currently:  

 

In San Diego, six hospital systems have committed $1.3 million to support a program called, “Nurses Now”, which will add faculty and additional student slots to San Diego University.  The American Hospital Association News reports that in Laredo, Texas, a hospital CEO worked with Texas A&M University to develop a four-year bachelor’s program and is providing $425,000 in scholarships to local students over the next five years.  In Morris County, New Jersey, the Board of Freeholders offered scholarships to students who agreed to work in a long term care facility.  The Dallas-Fort Worth Hospital Council raised $600,000 to expand student enrollment at local schools.  These are examples of various successful collaborative efforts among healthcare organizations, government, nursing associations and nursing schools. Many more are happening at the local level (2011).

 

Ineffective leadership and management continue to foster suboptimal work environments minimizing the rate of improvement in the nurse shortage and turnover rates.  According to Kleinman (2004), results from a study conducted by Volk and Lucas in 1991 revealed that “management style was the only predictor of anticipated turnover” (p. 129, para 4). This correlation further substantiates the amount of influence that nurse leaders have on healthcare organizations in a variety of ways including: decreased quality of care, loss of patients, increased nurse turnover, increased turnover of medical support staff, increased staffing costs, and increased accident and absenteeism rates (Hunt, 2009).  Work environment has also been cited as a significant predictor of nurse turnover.  Nurse autonomy, interactions with managers, compensation and workload are all factors that have been reported to facilitate job satisfaction or lack-there-of, ultimately determining staff retention and turnover (Huber, 2010).  Leaders need to be aware of and understand the current healthcare challenges and develop expertise in the skills and approaches requisite for effective leadership (O’Neill, 2013).  “People’s time and effort, as well as organizations’ money, facilities, and supplies, need to be directed in a coordinated effort to achieve best results and meet objectives” (Huber, 2010).

 

Over time, study results have been consistently indicative of the direct impact managers and leaders have on the quality of healthcare at every level.  The importance of highly qualified and effective nurse leaders is evident now more than ever and by improving the methods used to manage nurses, positive changes will be put into motion (Hunt, 2009). While the direct benefit would be decreasing the nurse shortage, this change would also significantly benefit the availability and quality of healthcare for everyone. Implementing enhanced methods of managing nurses would successfully result in improved staffing.  In fact, effective leadership and management may be the key to overcoming the nurse shortage and finally optimizing the quality of healthcare for all.

 

References:

 

AACN. Nursing shortage fact sheet.  Retrieved from http://www.aacn.nche.edu/media-relations/NrsgShortageFS.pdf 

 

Huber, D. (2010). Leadership and Nursing Care Management, 4th Edition. [Bookshelf Online]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781416059844/

 

Hunt, S. T. (2009). Nursing turnover: costs, causes, & solutions.  Retrieved from

 

https://www.nmlegis.gov/lcs/handouts/LHHS%20081312